Re my post earlier today, another friend from the UK responds as follows:
"First, big numbers always impress but I wanted to put them in context.
"In a western industrial society like the US or the UK you can expect 1% of your populate to die each year – for the US (the context of the paper) this means about 3 million deaths a year, of which 39,000 were estimated as being a result of errors (given the inadequacies of coding acknowledged by the author). This is just over 1% of deaths – too many perhaps, but at least its a number in context!
"The next group was Hospital Acquired Infections, which has then been a major focus in the UK for well over a decade, so perhaps the policy makers took note of this type of research and evidence early on.
"Then finally, adverse effects of medicines – which comes down to both the professionalism of medical practitioners and pharmacists, compliance by the patient and, perhaps most significantly, the growing complexity of patient need due to survival from previously deadly conditions and therefore significant rises in comorbidity in older age.
"The latter point requires new approaches to meeting the needs of people with complex/multiple conditions, something we are closely involved in through both our work with strategic workforce planners and others. We have also done extensive work in the area of end of life care services and continue to liaise with national policy makers in this area.
"There is therefore now significant emphasis, and some progress in the UK, on maintaining low levels of hospital acquired infections, training a workforce to meet complex multi-morbid needs amongst patients, and redesigning pathways and services so as to provide far more care outside of hospital.
"Scandals still happen though, and the Mid-Staffs review, which was born out of evidence of ‘excess hospital deaths’, is testimony to this.
"In my own mind this is in part due to an ‘over-industrialisation’ of the healthcare system, coupled with over-specialisation in the workforce and competition between NHS organisations driven by a silo approach to performance and target setting.
"All these are things that a healthy dose of Relational Thinking could address.
"Finally I was struck by the evidence and reference to inequalities being associated with poor health outcomes.
"There is a question about the adequacy of Rawlsian political philosophy to address health inequalities.
"I’m following up the reference in the paper you sent that suggests that more inequality, irrespective of the levels of wealth, leads to poorer health – that’s very interesting if competition drives inequality whilst collaboration creates a more mutually advantageous world-view and lifestyle."
No comments:
Post a Comment